Pathophysiologic mechanisms causing sleep apnea and hypoventilation in infants.

Complete absence of chemoreception in the medulla is characterized by sustained hypoventilation. Except for the first months of life, this deficit does not, of itself, cause apnea. Both in infants who lack central chemical drive, as well as those who are only partly deficient, it is necessary to invoke at least one further pathophysiologic event.

Swan-Ganz catheterization in the critically ill newborn.

The authors placed Swan-Ganz catheters in 11 preterm and 2 term infants with severe cardiopulmonary distress. The infants ranged in weight from 1100-4000 g. The procedure was performed in the neonatal ICU by jugular venous cutdown.

Neurologic sequelae in the survivors of neonatal intraventricular hemorrhage.

We report our experience with the neurologic sequelae (at a mean follow-up of 24 months) among the 15 surviving infants who have had neonatal intraventricular hemorrhage (IVH) documented by computerized tomographic (CT) brain scan. Neurologically six infants (40%) are normal, six infants (40%) mildly impaired, and three infants (20%) moderate to severely impaired. The neurologic outcome correlated to the degree of hemorrhage seen in the CT scans when IVH was classified into four grades.

Surgical treatment of long-term sensorineural hearing loss due to labyrinthine fistula.

Perilymphatic fistula, usually in the round or oval window, causes a variety of symptoms, including sensorineural hearing loss. Surgical repair of these fistulas has resulted in restoration of hearing in some cases. It has been suggested that surgery must be performed within 2 months of the trauma if improvement in hearing is to occur.

Periodic breathing in infants with near-miss sudden infant death syndrome.

Twelve-hour nocturnal home recordings of respiration and heart rates were obtained during sleep in 32 infants with near-miss sudden infant death syndrome (SIDS) and in 32 control infants, and the recordings were analyzed for periodic breathing. An episode of periodic breathing was defined as three or more apneic pauses of three or more seconds. The duration of respirations interrupting the pauses was 20 seconds or less.

Respiratory and nonrespiratory effects of doxapram in congenital central hypoventilation syndrome.

Doxapram is a respiratory stimulating drug that affects both peripheral chemoreceptors and medullary respiratory and nonrespiratory neurons. We administered doxapram 60 2 infants with congenital central hypoventilation syndrome. In 6 separate trials at a dose range of 0.

Preferential distribution of lobar emphysema and atelectasis in bronchopulmonary dysplasia.

The chest roentgenograms of 142 neonates who survived mechanical ventilation for respiratory distress syndrome (N = 99) and prolonged apnea (N = 43) were reviewed. Thirty-seven infants had bronchopulmonary dysplasia (BPD) and 17 of these developed lobar hyperinflation of the right lower lobe and collapse of the right upper lobe. Regional lung function was measured with a xenon 133 technique in three of these infants and in five other patients who either died or were lost to follow-up.

Ovine nasal adenopapilloma: incidence and clinicopathologic studies.

Nasal adenopapillomas were observed in 9 Y'anKasa and 1 Y'anKasa-Suffolk crossbred sheep (8 females and 2 males) over a 20-month period. The neoplasms originated from the epithelium of the lateral mass of the ethmoid bone. Gross and histologic features and clinical signs were similar in all cases.

Screening for impaired visual acuity in middle age in general practice.

Screening for impaired distant visual acuity was one component of a controlled trial of multiphasic screening in middle age carried out in two general practices. The prevalence of impaired visual acuity (6/18 or worse in the better eye) at the initial screening in 1967 was 9.6% overall, ranging from 5.

The relationship of bronchopulmonary dysplasia to the occurrence of alveolar rupture during positive pressure ventilation.

The effect of altered mechanical ventilation on the incidence of alveolar rupture and bronchopulmonary dysplasia (BPD) was reviewed in infants who had neonatal respiratory distress syndrome (RDS) (N = 99). From 1971 to 1974 we attempted to minimize pulmonary oxygen exposure. Accordingly, during the resolution of respiratory distress syndrome, the ventilator pressures were not reduced until the FIO2 had been lowered to 0.

Care of infants with near-miss sudden infant death syndrome.

The purpose of this study was to evaluate the effectiveness of home management of life-threatening apnea in infants with near-miss sudden infant death syndrome (SIDS). A total of 84 infants were monitored with apnea monitors for an average of seven months (range 1 to 27). A group of 27 infants had episodes of apnea requiring resuscitation during home monitoring, all of whom were successfully resuscitated by their parents on at least one occasion using bag and mask resuscitation, and 17 infants required more than one resuscitation.

Inappropriate antidiuretic hormone secretion in premature infants with cerebral injury.

We describe 11 premature infants with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The syndrome is far more common than the single case report in the literature would indicate. All the infants had either asphyxiation at birth, intracranial hemorrhage, or meningitis.

Monitoring occlusion and accidental extubation of tracheostomy tubes in children.

Twelve infants and children with tracheostomies have been monitored for occlusion or accidental extubation in hospital and at home using a thermistor-electronic monitor. The patients ranged from 1 month to 6 years of age and have been monitored for 1 to 16 months. The device sounds an alarm when it fails to sense the warming of air on expiration.

Abnormal regulation of ventilation in infants at risk for sudden-infant-death syndrome.

To test whether alveolar hypoventilation and an abnormal ventilatory response to inhaled carbon dioxide explains some episodes of sudden-infant-death syndrome, we assessed ventilatory control during quiet sleep in 12 normal infants and 11 infants who had required at least two resuscitations because of prolonged apnea (greater than 20 seconds) during sleep (aborted form of the syndrome). Infants with the aborted syndrome hypoventilated during quiet sleep (alveolar partial pressure of carbon dioxide, 38.9+/-3.

Pediatricians' attitudes affecting decision-making in defective newborns.

A questionnaire designed to identify the factors that influence the resolution of ethical dilemmas was returned by 230 (57% of the total) Massachusetts pediatricians. The decision to recommend surgery for an infant with Down's syndrome with duodenal atresia when the parents had refused surgery was influenced by religious affiliation (P less than .01), religious activity (P less than .

Infantile lobar hyperinflation: expectant treatment.

Arterial blood gases and regional lung function, measured with a 133xenon technique, were used to evalute the physiological defects and follow the natural history of 16 infants with lobar hyperinflation ("emphysema"). Hypoxemia was due to V/Q inequality at rest. Worsening of hypoxemia (mean Pao2 delta--26 mm Hg) with crying was due to shunting as a consequence of cessation of ventilation in the involved lobe.

Pulmonary edema associated with croup and epiglottitis.

Two children, ages 9 and 2 1/2 years, with clinical diagnoses of laryngotracheitis (croup) and epiglottis, respectively, developed florid pulmonary edema without evidence of cardiac enlargement. Both children responded to vigorous therapy, which included endotracheal intubation, mechanical ventilation with high oxygen concentrations and positive end expiratory pressure, diuretics, and support of the intravascular volume with colloid infusions. Swan-Ganz catheterization was performed in the child with epiglottitis to elucidate any hemodynamic malfunction.

The role of the QT interval in the sudden infant death syndrome.

To evaluate the role of QT interval prolongation in the genesis of the sudden infant death syndrome (SIDS), the post-resuscitation electrocardiograms of 21 aborted SIDS infants were reviewed. The infants had been found apneic, cyanotic, limp and unresponsive during sleep and required vigorous physical stimulation and mouth-to-mouth resuscitation. Three subsequently experienced repeat similar episodes from which they could not be resuscitated.